Objective: To compare crown-root angulations of the permanent maxillary anterior teeth in skeletal Class I, Class II, and Class III Korean malocclusion patients using cone-bean computed tomography (CBCT) images. Methods: Sixty CBCT images were collected from orthodontic patients archive based on skeletal Class I (0˚< A point-nasion-B point angle [ANB] < 4˚), Class II (ANB ≥ 4˚), and Class III (ANB ≤ 0˚) to have 20 samples in each group. Mesiodistal crown-root angulation (MDCRA) and labiolingual crown-root angulation (LLCRA) were evaluated after orientation of images. Crown-root angulations were compared among Class I, Class II, and Class III groups and among the maxillary anterior teeth in each group. Results: LLCRAs of the maxillary central incisor and the lateral incisor were significantly lower in Class III group than those in Class I group. However, those of the canine showed no significant differences among groups. MDCRAs of the maxillary anterior teeth did not significantly differ among groups either. Conclusions Our results suggest that skeletal Class III malocclusion might affect LLCRA of the maxillary incisors, especially the central incisor.

Orthognathic surgery is the primary treatment option for severe skeletal discrepancy. However, orthodontic camouflage should be considered as an alternative treatment option, considering the risks of surgery. A 19.5-yearold man presented with a severe prognathic mandible with a Class III molar relationship and an anterior crossbite. Orthognathic surgery could be considered because of his severe skeletal discrepancy and mandibular prognathism. However, the anesthetist for orthognathic surgery did not recommend surgery under general anesthesia because of risk factors associated with the patient’s aplastic anemia, including bleeding and infections. Thus, a camouflage treatment to promote backward rotation of the mandible via orthodontic extrusion of the posterior teeth was planned. An anterior bite plate, intermaxillary elastics, and fixed orthodontic appliances were used to extrude the posterior teeth and to align the dentition. After 17 months of nonsurgical orthodontic treatment, normal occlusion was achieved, and the facial profile was dramatically improved. This case report describes the dentoskeletal and soft-tissue effects of mandibular rotation and its long-term stability.

BACKGROUND: A 9-year-old male showed severe defects in midface structures, which resulted in maxillary hypoplasia, ocular hypertelorism, relative mandibular prognathism, and syndactyly. He had been diagnosed as having Apert syndrome and received a surgery of frontal calvaria distraction osteotomy to treat the steep forehead at 6 months old, and a surgery of digital separation to treat severe syndactyly of both hands at 6 years old. Nevertheless, he still showed a turribrachycephalic cranial profile with proptosis, a horizontal groove above supraorbital ridge, and a short nose with bulbous tip. METHODS: Fundamental aberrant growth may be associated with the cranial base structure in radiological observation. RESULTS: The Apert syndrome patient had a shorter and thinner nasal septum in panthomogram, PA view, and Waters’ view; shorter zygomatico-maxillary width (83.5 mm) in Waters’ view; shorter length between the sella and nasion (63.7 mm) on cephalogram; and bigger zygomatic axis angle of the cranial base (118.2°) in basal cranial view than a normal 9-year-old male (94.8 mm, 72.5 mm, 98.1°, respectively). On the other hand, the Apert syndrome patient showed interdigitating calcification of coronal suture similar to that of a normal 30-year-old male in a skull PA view. CONCLUSION: Taken together, the Apert syndrome patient, 9 years old, showed retarded growth of the anterior cranial base affecting severe midface hypoplasia, which resulted in a hypoplastic nasal septum axis, retruded zygomatic axes, and retarded growth of the maxilla and palate even after frontal calvaria distraction osteotomy 8 years ago. Therefore, it was suggested that the severe midface hypoplasia and dysostotic facial profile of the present Apert syndrome case are closely relevant to the aberrant growth of the anterior cranial base supporting the whole oro-facial and forebrain development.
Acrocephalosyndactylia ; Adult ; Child ; Exophthalmos ; Forehead ; Hand ; Humans ; Hypertelorism ; Male ; Maxilla ; Nasal Septum ; Nose ; Osteotomy ; Palate ; Prognathism ; Prosencephalon ; Skull ; Skull Base ; Sutures ; Syndactyly

INTRODUCTION: Identifying menton (Me) on posteroanterior cephalograms and three-dimensional (3D) cone-beam computed tomography (CBCT) images is difficult, because the midpoint of the symphyseal area is not identifiable after the mandibular symphysis fuses at an early age. The aim of this study was to evaluate the reliability of the identification of the genial tubercle (GT) in patients with mandibular asymmetry and to compare it with that of the traditional landmark, Me. METHODS: The samples comprised 20 CBCT images of adults with mandibular asymmetry. Two examiners performed the identifications and measurements. Me and GT were marked, and the anteroposterior, vertical, and transverse distances to the three reference planes were measured on 3D-reconstructed CBCT images. The intra- and inter-examiner reliability of landmark identification of Me and GT were assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots. RESULTS: The Me and GT landmarks showed excellent reliability (ICC ≥ 0.993) three-dimensionally. In the transverse evaluation, the ICC values of the GT (range, 0.997–0.999) tended to be slightly higher than those of Me (range, 0.993–0.996). In the Bland-Altman plots for the two separate assessments, Me showed a maximum error of 1.76 mm in the transverse direction, whereas the GT showed a maximum error of 0.96 mm in the 95% limit. CONCLUSIONS: Our results suggest that both Me and GT are clinically reliable and equally useful landmarks for the evaluation of mandibular asymmetry on CBCT images.
Adult ; Cone-Beam Computed Tomography ; Diagnosis* ; Humans ; Prospective Studies*

PURPOSE: We evaluated the geometric discrepancies between the proximal femur in Koreans and two types of proximal femoral nail using plain radiographs. MATERIALS AND METHODS: A total of 100 consecutive patients (38 treated with proximal femoral nail antirotation [PFNA], 62 PFNA II) with intertrochanteric fracture were retrospectively identified. The minimum follow up period was 32 months. The geometric analysis of the proximal femur was performed using preoperative true hip antero-posterior radiographs of the unaffected side, and the data were compared with the PFNA and PFNA II dimensions. Postoperative assessments were performed using postoperative radiographs for the proximal protruding length of nail tip, quality of reduction, implant position and the presence of lateral cortical impingement. RESULTS: The geometric dimensions of the proximal femur were different between the two proximal femoral nail types. No impingement was detected in patients treated with PFNA II, whereas 13 cases of lateral impingement were observed in patients treated with PFNA. A significant association was observed between the short proximal femur and the presence of lateral cortical impingement (P=0.032) and between impingement and intraoperative reduction loss (P=0.012). Proximal protrusion of the nail tip was seen in 71 patients and no difference was observed between two groups. CONCLUSION: Our study demonstrates that the flat lateral surface of PFNA II can avoid lateral cortical impingement, which provide better fixation for intertrochanteric fracture. However, there was still a problem associated with longer proximal end of PFNA II compared with the proximal femoral length in Korean.
Femoral Fractures* ; Femur ; Follow-Up Studies ; Hip ; Humans ; Retrospective Studies

Entrapment of the ulnar nerve around the elbow is the second most common compression neuropathy in the upper extremity. Many anatomical regions that possibly compress the ulnar nerve around the elbow joint have been described, however few cases below the flexor carpi ulnaris muscle have been reported. A case with ulnar nerve entrapment at the flexor pronator aponeurosis, secondary to surgery is reported in this study.
Cubital Tunnel Syndrome* ; Elbow ; Elbow Joint ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes ; Upper Extremity

PURPOSE: This study was performed to investigate the bone thickness of the infrazygomatic crest area by computed tomography (CT) for placement of a miniplate as skeletal anchorage for maxillary protraction in skeletal Class III children. MATERIALS AND METHODS: CT images of skeletal Class III children (7 boys, 9 girls, mean age: 11.4 years) were taken parallel to the Frankfurt horizontal plane. The bone thickness of the infrazygomatic crest area was measured at 35 locations on the right and left sides, perpendicular to the bone surface. RESULTS: The bone was thickest (5.0 mm) in the upper zygomatic bone and thinnest (1.1 mm) in the anterior wall of the maxillary sinus. Generally, there was a tendency for the bone to be thicker at the superior and lateral area of the zygomatic process of the maxilla. There was no clinically significant difference in bone thickness between the right and left sides; however, it was thicker in male than in female subjects. CONCLUSION: In the infrazygomatic crest area, the superior and lateral area of the zygomatic process of the maxilla had the most appropriate thickness for placement of a miniplate in growing skeletal Class III children with a retruded maxilla.
Child ; Female ; Humans ; Male ; Maxilla ; Maxillary Sinus ; Orthodontic Anchorage Procedures ; Zygoma

Congenital Abnormalities ; Facial Asymmetry ; Humans ; Imaging, Three-Dimensional ; Lip ; Mouth ; Orthognathic Surgery ; Osteotomy

BACKGROUND/AIMS: In 2010, the American Diabetes Association (ADA) adopted glycated hemoglobin (HbA1c) as a new diagnostic criterion for diabetes mellitus. However, HbA1c values may differ among races. We determined whether this criterion could be applied to Korean diabetics. METHODS: Between January 2000 and January 2010, 1,862 patients among Konyang University Hospital visitors in which the 75 g oral glucose tolerance test (OGTT) and HbA1c were checked at the same time were enrolled. We excluded patients with acute disease, an Hb < or = 10 g/dL, a Cr > or = 2 mg/dL, those prescribed oral hypoglycemic agents or insulin, and those who were pregnant. RESULTS: After applying the exclusion criteria, 1,474 Korean patients were enrolled. All had common features of Korean diabetics for body mass index and homeostatic model assessment of insulin resistance values. Using the 0 and 120 minute glucose levels of the OGTT from the receiver operating characteristic curve, the HbA1c cutoff value was 6.25%. The cutoff value to diagnose diabetes with the presence of diabetic retinopathy was 6.75%. CONCLUSIONS: Our study showed a difference between the HbA1c values for diagnosing diabetes and the new diagnostic criterion from the ADA. Considering that the HbA1c characteristics may be influenced by race or culture, larger studies on diabetes complications are needed to identify the appropriate HbA1c value for Korean diabetics.
Acute Disease ; Body Mass Index ; Continental Population Groups ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Retinopathy ; Glucose ; Glucose Tolerance Test ; Hemoglobins ; Humans ; Hypoglycemic Agents ; Insulin ; Insulin Resistance ; Korea ; ROC Curve

PURPOSE: This retrospective study was performed to investigate the prevalence of the idiopathic osteosclerosis (IO) in Korean malocclusion patients according to age, sex, and the Angle's classification of malocclusion. MATERIALS AND METHODS: This study consisted of 2,001 randomly selected patients from the Department of Orthodontics at the Gangneung-Wonju National University Dental Hospital, Korea. The prevalence of IO in Korean malocclusion patients was recorded using their panoramic radiographs, and the following parameters were surveyed; age, sex, and the Angle's classification of malocclusion. The chi-square test was analyzed to determine the statistical significance of differences in the prevalence of IO between age, sex, and the Angle's classification of malocclusion. RESULTS: The prevalence of IO in the jaws was 6.7% in a total of 2,001 examined orthodontic patients. The majority of IO was found in the mandible (96.58%). The 30-39 age group showed the highest prevalence of IO (9.60%). There was a higher prevalence in females (6.89%) than in males (6.45%). The prevalence of IO in Angle Class I group (7.07%) was the most frequent, followed by Angle Class II group (6.72%), and Angle Class III group (6.40%). However, there was no statistical significance in sex and Angle's classification of malocclusion. CONCLUSION: The prevalence of IO in malocclusion patients showed the differences between various age groups and most of them were found in the mandibular posterior area. However, sex and the type of malocclusion are not to be considered as a contributing factor of IO.
Female ; Humans ; Jaw ; Korea ; Male ; Malocclusion ; Malocclusion, Angle Class I ; Malocclusion, Angle Class II ; Malocclusion, Angle Class III ; Mandible ; Orthodontics ; Osteosclerosis ; Prevalence ; Radiography, Panoramic ; Retrospective Studies